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Nipple and areola reconstruction

You can decide if you want to have your nipple and the dark area around the nipple (areola) reconstructed. Nipple areola reconstructions usually are the final phase of breast reconstruction. This is a separate surgery done to make the reconstructed breast look more like the original breast. It can be done as an outpatient procedure after the area is numbed (with local anesthesia). It’s usually done after the new breast has had time to heal (about 3 to 4 months after surgery).

Ideally, nipple and areola reconstruction matches the position, size, shape, texture, color, and projection of the new nipple to the natural one. Tissue used to rebuild the nipple and areola is taken from your body, such as from the newly created breast, opposite nipple, ear, eyelid, groin, upper inner thigh, or buttocks. In some cases, doctors build up the areola and nipple area with donor skin that’s had the cells removed. (See “New methods of tissue support” for more on donor skin products.) Tattooing may be used to match the color of the nipple and areola of the other breast.

Some people opt to have just the tattoo, without nipple and areola reconstruction. A skilled plastic surgeon may be able to use pigment in shades that make the flat tattoo look 3-dimensional.

Nipple-sparing procedures

In a nipple-sparing mastectomy or areola-sparing mastectomy, the nipple and/or areola are left in place while the breast tissue under them is removed. Women who have a small cancer near the outer part of the breast, with no signs of cancer in the skin or near the nipple, might be able to have nipple-sparing surgery. (Cancer cells are more likely to be hidden in the nipple if the breast tumor is larger or close to the nipple, which means there is a higher risk the cancer will come back if the nipple is not removed.) Some doctors give the nipple tissue a dose of radiation during or after the surgery to try to reduce the risk of the cancer coming back. In areola-sparing mastectomy, the nipple itself, including its ducts, may be removed while the circle of tissue around it is kept.

Nipple-sparing operations have some problems. Afterward, the nipple does not have a good blood supply, so sometimes it can wither away or become deformed. Because the nerves are also cut, there’s little or no feeling in the nipple. In some cases, the nipple may look out of place later, mostly in women with larger breasts. Doctors are working to improve the safety and outcomes of nipple-sparing surgeries.

Saving the nipple from the breast that has been removed to use it later (called nipple saving or nipple banking) is no longer favored by most surgeons. The tissue can be injured by the way it’s stored or preserved, and there have been other problems with this surgery. A few researchers are still trying different ways to make this work, but the methods are not ready for general use.